Bartoš Vladimír, Korec Peter, Ficek Robert
Department of Pathology, Faculty Hospital in Žilina, Slovakia.
Department of Surgery, Faculty Hospital in Žilina, Slovakia.
Acta Medica (Hradec Kralove). 2018;61(1):29-32. doi: 10.14712/18059694.2018.20.
Leiomyomas are the most common benign tumor of the uterus. Occasionally, they may reach an extreme dimension. The authors present a case of a 44-year old woman, who suffered a car accident as a driver of personal motor vehicle. At the hospital, a huge tumor mass filling the entire abdominopelvic cavity was incidentally detected. The patient admitted a progressive abdominal enlargement for the last 5 years. An urgent laparotomy was performed, during which a giant, well-demarcated tumor arising from the uterine body had been disclosed. It was completely surgically removed and sent for histopathology. Grossly, the tumor measured 30 × 30 × 20 cm in the largest diameters and weighed 8.1 kg. The tissue was markedly edematous with foci of massive hemorrhages and contained confluent pseudocystic formations of various sizes, filled with a fluid and fresh blood. Solid foci of rubber consistency were also visible. Microscopic examination revealed a conventional subserous uterine leiomyoma with marked regressive and degenerative changes. Giant uterine leiomyomas occur extremely rare, but because of the often unexpected finding and atypical presentation, they may represent a great diagnostic challenge for both, pathologists and clinicians. At the biopsy examination, a multiple-section sampling is very important to avoid the possibility of underlying malignancy.
平滑肌瘤是子宫最常见的良性肿瘤。偶尔，它们可能会长得极大。作者报告了一例44岁女性病例，该女性作为私人机动车驾驶员遭遇了一场车祸。在医院，偶然发现一个巨大的肿瘤团块占据了整个腹腔盆腔。患者自述在过去5年中腹部逐渐增大。遂进行了急诊剖腹手术，术中发现一个源自子宫体的巨大、边界清晰的肿瘤。该肿瘤被完全手术切除并送去做组织病理学检查。大体上，肿瘤最大直径为30×30×20厘米，重8.1千克。组织明显水肿，有大片出血灶，并含有大小不一的融合性假囊肿形成，内有液体和新鲜血液。还可见到橡皮样质地的实性病灶。显微镜检查显示为典型的浆膜下子宫平滑肌瘤，伴有明显的退行性和变性改变。巨大子宫平滑肌瘤极为罕见，但由于其常为意外发现且表现不典型，对病理学家和临床医生而言都可能构成巨大的诊断挑战。在活检检查时，多部位取材非常重要，以避免存在潜在恶性肿瘤的可能性。
